MultiPlan Health Insurance For Addiction Treatment

MultiPlan serves over 700 healthcare clients. Their customers are primarily health insurance companies and self funded employers along with government entities that pay for healthcare.

MultiPlan’s primary product is the PHCS provider network which is a national preferred provider organization (PPO). They also offer complementary provider networks that increase availability, fill in provider gaps, and improve access to specialty care.

MultiPlan reviews bills from network and out of network providers and negotiates out of network charges to save money for both clients and patients. This process allows them to detect wrong billing codes and catch potential fraud.

Does MultiPlan Cover Addiction Treatment?

The PHCS provider network includes over a million healthcare providers across the country, and some of them provide substance use and mental health treatment. However, it’s not MultiPlan’s decision what care is covered — the insurance company or self funded employer determines that.

If the insurance plan that uses the PHCS network falls under the Affordable Care Act, then it will have to cover 10 essential health benefits which include mental health and addiction treatment. However self funded insurance plans aren’t subject to the ACA so they may or may not cover rehab.

That’s why it’s so important to verify your insurance details before you commit to treatment. You may also need a referral or preauthorization for coverage for example. When you check in advance you can avoid any surprises while you’re trying to focus on recovery.

What Inpatient Addiction Treatment Does MultiPlan Cover?

MultiPlan has developed a network of providers and treatment facilities that insurance companies utilize to provide their members with quality care. However they don’t determine the actual amount of coverage you have.

Your insurance provider focuses on offering medically necessary care, including treatment for addiction and mental health conditions. This is why it is crucial to have a treatment plan from your primary care physician. This plan helps support the medical necessity of inpatient addiction treatment.

The American Society of Addiction Medicine (ASAM) provides a multidimensional assessment tool so your clinician can assess the severity of substance use disorders and co occurring mental health conditions. The assessment criteria help inform your placement and treatment and will indicate when residential care is more appropriate. These criteria can include the severity of your addiction and any co occurring mental health disorders as well as an unstable living environment and safety concerns.

Your addiction treatment may start with medical detoxification. A medical detox program uses approved prescription medications to reduce withdrawal symptoms. During the program you are monitored 24/7 to reduce the potential life threatening side effects of withdrawal from certain drugs.

After addictive substances have been detoxed from your body you may transition to an evidence based inpatient treatment program. These programs use therapeutic approaches like cognitive behavioral therapy and dialectical behavior therapy as well as motivational interviewing. The combination approach of medical detoxification and residential care supports your recovery journey by providing you with a highly structured environment that is far away from drug and alcohol addiction triggers.

What Outpatient Rehab Does MultiPlan Cover?

After a comprehensive evaluation, potentially including the ASAM, your customized treatment program may begin with inpatient services or outpatient care. Several levels of outpatient care may be part of your tailored treatment plan.

Before enrolling in an outpatient treatment program you must check with your insurance plan to determine your coverage benefits and limitations. Multiplan offers the network of providers but they do not make coverage decisions.

The first level of outpatient care is a Partial Hospitalization Program (PHP) which offers a highly structured and intensive outpatient treatment. The program is often very similar to what you would receive as an inpatient but you return home in the evening. This treatment program is ideal for you when you have a stable home environment.

After a PHP you may graduate to an Intensive Outpatient Program (IOP). These programs provide evidence based therapy using a more flexible schedule. You may receive care for several hours a day over several days each week. Some treatment centers with IOPs allow you to choose sessions in the morning or afternoon or evening, which allows you to meet your work and school obligations.

A general outpatient treatment program has greater flexibility and usually includes treatment once or twice a week.

After completing your outpatient addiction treatment you may transition into an aftercare program. These programs support your long term sobriety and sustainable recovery.

Does MultiPlan Cover Methadone & Suboxone (MAT)?

Medication assisted treatment (MAT) is available for opioid and alcohol addiction programs. MAT can be used for medical detoxification to help reduce withdrawal symptoms and lessen the risk of life threatening complications. It can also be used for ongoing treatment to help reduce cravings and reduce the risk of relapse.

FDA approved prescription drugs such as methadone and buprenorphine along with naltrexone and suboxone are commonly prescribed in a MAT treatment program. Methadone and buprenorphine are usually used only for opioid treatment programs and Naltrexone can be used for alcohol and opioid use disorders. Suboxone is a combination of buprenorphine and Naltrexone that helps reduce cravings and reduce the risk of an overdose.

Does MultiPlan Cover Other Mental Healthcare?

MultiPlan’s network of healthcare professionals includes mental health providers. However your insurance plan makes coverage decisions about treatment, including the type of therapy and duration of care they will cover.

Mental health conditions can occur independently or as co occurring disorders alongside a substance use disorder. In either case, mental health care is essential to help stabilize you and ensure you have access to crisis support and therapy.

When a mental health condition is a co occurring disorder your treatment must be integrated to treat both conditions for a successful long term recovery. Your treatment program must include therapists with experience treating co occurring conditions which is also called a dual diagnosis.

Most plans offer mental health coverage as they are regulated by the Affordable Care Act. However, there are exceptions and self funded insurance plans are one exception. It is crucial you verify your insurance coverage before enrolling in treatment so you don’t receive a surprise bill.

How Long Will MultiPlan Cover Rehab?

Your insurance provider makes decisions about your coverage benefits and limitations. They also decide about the requirements that must be met before they pay for treatment. For example, your insurance plan may require prior authorization before treatment. Documentation may include an ASAM assessment and a treatment plan from your physician along with a medical examination or other information.

Your treatment center can usually help you gather the necessary information to submit prior authorization. Your insurance company will also look at certain criteria to determine how long you may receive addiction treatment. These criteria are based on medical necessity.

Your insurance provider will likely work with the treatment center and base decisions on your progress in care. Your length of stay in an inpatient or outpatient program will depend on the severity of your addiction and how well you respond to treatment. Most treatment centers offer 30 or 60 or 90 day programs.

Does Addiction Treatment Need to Be In Network?

MultiPlan’s primary network of providers is a preferred provider organization (PPO). Generally your insurance plan will offer some coverage for out of network providers. However, these are usually at a higher cost. For example receiving out of network treatment will likely have higher deductibles and copayments.

You can maximize your insurance coverage and receive more evidence based therapy — whether inpatient or outpatient — when you use an in network provider. The best way to accomplish this is to review your plan with your insurance company or to discuss your payment options with the treatment center. Most treatment centers will verify your insurance coverage before treatment begins and will know if they are in network or out of network with your insurance plan.

How to Verify Coverage With MultiPlan

Before receiving treatment it’s very important to verify your insurance coverage with your insurance provider. MultiPlan may be able to help you identify your particular plan but they may not know the requirements and benefits or limitations of your coverage.

Most insurance providers have customer service phone numbers and online platforms where you can check your insurance coverage. However sometimes the easiest way is to work with your treatment center. They are often adept at verifying insurance coverage and identifying the necessary requirements before admission.